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欧 俊, 倪 坤, 马 潞, 王 国, 颜 野, 杨 斌, 李 庚, 宋 昊, 陆 敏, 叶 剑, 张 树. [Prognostic factors of patients with muscle invasive bladder cancer with intermediate-to-high risk prostate cancer]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2024; 56:582-588. [PMID: 39041549 PMCID: PMC11284458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer (MIBC) with intermediate-to-high-risk primary prostate cancer. METHODS From January 2012 to October 2023, the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed. All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study. Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients. For significant influencing factors (pathological T stage, M stage and perineural invasion of bladder cancer), survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors. RESULTS A total of 32 patients were included in this study. The mean age was (72.5±6.6) years; the median preoperative total prostate specific antigen (tPSA) was 6.68 (2.47, 6.84) μg/L; the mean preoperative creatinine was (95±36) μmol/L, and the median survival time was 65 months. The majority of the patients (87.5%) had high-grade bladder cancer, 53.1% had lymphatic invasion, and 31.3% had perineural invasion. Prostate involvement was observed in 25.0% of the cases, and the positive rate of soft-tissue surgical margin was 37.5%. Multivariate Cox analysis revealed that preoperative creatinine level (HR=1.02, 95%CI: 1.01-1.04), pathological stage of bladder cancer T3 (HR=11.58, 95%CI: 1.38-97.36) and T4 (HR=19.53, 95%CI: 4.26-89.52) metastasis of bladder cancer (HR=9.44, 95%CI: 1.26-70.49) and perineural invasion of bladder cancer (HR=6.26, 95%CI: 1.39-28.27) were independent prognostic factors (P < 0.05). Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3, T4, M1, and perineural invasion were unfavorable factors affecting the patients' survival prognosis (P < 0.05). CONCLUSION Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis. High preoperative serum creatinine, T3 or T4 pathological stage of bladder cancer, metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.
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Affiliation(s)
- 俊永 欧
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 坤明 倪
- 北京大学第三医院病理科,北京 100191Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - 潞林 马
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 国良 王
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 野 颜
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 斌 杨
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 庚午 李
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 昊东 宋
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 敏 陆
- 北京大学第三医院病理科,北京 100191Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - 剑飞 叶
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 树栋 张
- 北京大学第三医院泌尿外科,北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
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Wu K, Liu X, Tang Y, Wang X, Li X. Clinicopathologic characteristics and outcomes of prostate cancer incidentally discovered at the time of radical cystoprostatectomy: a population-based cohort study. Int J Surg 2024; 110:4023-4030. [PMID: 38537072 PMCID: PMC11254266 DOI: 10.1097/js9.0000000000001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/11/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE This study aimed to comprehensively analyze the clinical characteristics and prognosis of patients with concomitant bladder cancer (BCa) and prostate cancer (PCa) using a large population-based database. METHODS Within the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019), the authors identified patient with concomitant PCa at the time of radical cystoprostatectomy (RCP). Logistic regression and propensity score matching (PSM) analyses were employed to identify risk factors and mitigate confounders, respectively. Kaplan-Meier survival curves were used to estimate cancer-specific survival (CSS). RESULTS A total of 14 199 BCa patients undergoing RCP were identified, with 28.8% incidentally discovered to have concurrent PCa. Among them, 89.9% exhibited organ-confined (T1-2) PCa. An increased risk of concomitant tumors was observed among older age, white race, and high tumor grade of BCa. Survival analysis revealed no significant difference in CSS between patients with BCa alone and those with concurrent PCa (5-year CSS rate: 71.3 vs. 67.2%, P =0.076). Subgroup analysis and multivariable analysis, however, indicated that concurrent high-risk PCa adversely impacted survival (5-year CSS rate: 71.3 vs. 63.4%, HR 1.27, 95% CI: 1.01-1.58, P =0.038) compared to solitary BCa. Notably, the presence of low/intermediate-risk PCa did not affect survival outcomes ( P =0.584). CONCLUSION In conclusion, incidentally discovered PCa in RCP specimens is frequent and characterized by organ-confined presentation, lower PSA levels, and Gleason scores. Patients with concurrent high-risk PCa have a worse prognosis compared to those with solitary BCa, while the presence of low/intermediate-risk PCa does not influence oncological prognosis.
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Affiliation(s)
- Kan Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University
| | - Xu Liu
- Breast Center, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Yaxiong Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University
| | - Xianding Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University
| | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University
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Wu S, Lin SX, Lu M, Subtelny AO, Wang Z, Dahl DM, Olumi AF, Wu CL. Assessment of 5-year overall survival in bladder cancer patients with incidental prostate cancer identified at radical cystoprostatectomy. Int Urol Nephrol 2019; 51:1527-1535. [PMID: 31183659 DOI: 10.1007/s11255-019-02181-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/23/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the oncological impact of incidental prostate cancer (iPCa) found during radical cystoprostatectomy (RCP) on overall survival (OS) prognosis of urothelial carcinoma of the bladder (BCa). PATIENTS AND METHODS A total of 122 RCP cases resected between 2002 and 2012 at our center were included for study. Survival of BCa patient was compared using the Kaplan-Meier method and the log-rank test. Cox proportional hazards regression models were used to analyze the impact of iPCa on the 5-year overall mortality of BCa patients after RCP. RESULTS Among the 122 BCa cases that underwent RCP, 38 cases (31.1%) had iPCa, in which, 17 cases (44.7%) were identified as clinically significant iPCa (csPCa). BCa patients with iPCa were older (71 vs 64 years, p = 0.004) and had higher preoperative PSA level (3.1 ng/mL vs 1.4 ng/mL, p = 0.017) when compared to those without iPCa. Cases with iPCa showed a more favorable 5-year OS than cases without iPCa, although this difference did not reach statistical significance (p = 0.219). When excluding the higher risk cases with Gleason score (GS) ≥ 4 + 3 and/or preoperative PSA > 10 ng/mL, BCa patients with iPCa showed a significantly longer OS than cases without iPCa on univariate analysis (p = 0.044), but not on multivariate analysis (p = 0.125). CONCLUSION Our results demonstrated that the frequent findings of low-risk iPCa in BCa patients could indicate the potential possibility of shared pathogenesis pathways between iPCa and BCa. Future study with a larger cohort is warranted to validate this result.
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Affiliation(s)
- Shulin Wu
- Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Warren Building 225, 55 Fruit Street, Boston, MA, 02114, USA
| | - Sharron X Lin
- Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Warren Building 225, 55 Fruit Street, Boston, MA, 02114, USA
| | - Min Lu
- Department of Pathology, Peking University Health Science Center, Beijing, China
| | - Alexander O Subtelny
- Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Warren Building 225, 55 Fruit Street, Boston, MA, 02114, USA
| | - Zongwei Wang
- Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Warren Building 225, 55 Fruit Street, Boston, MA, 02114, USA
| | - Douglas M Dahl
- Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Warren Building 225, 55 Fruit Street, Boston, MA, 02114, USA
| | - Aria F Olumi
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Chin-Lee Wu
- Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Warren Building 225, 55 Fruit Street, Boston, MA, 02114, USA.
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Kraus RD, Hamilton AS, Carlos M, Ballas LK. Using hospital medical record data to assess the accuracy of the SEER Los Angeles Cancer Surveillance Program for initial treatment of prostate cancer: a small pilot study. Cancer Causes Control 2018; 29:815-821. [PMID: 30022335 DOI: 10.1007/s10552-018-1057-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Treatment information from the Surveillance, Epidemiology, and End Result Program (SEER) cancer registries is increasingly being used for population-based cancer research; however, it may be incomplete for outpatient procedures and is not quality controlled. We sought to validate SEER information on initial treatment of prostate cancer by comparison to electronic medical record (EMR) review. METHODS Patients diagnosed with prostate cancer between 1 January 2010 and 31 December 2014 in Los Angeles County who received treatment at our institution within 6 months of diagnosis were identified from the SEER registry. We reviewed the hospital EMR for these patients and identified initial treatment received within 6 months of diagnosis. We compared data reported to SEER data to our re-abstracted hospital EMR data (defined as the gold standard) to identify the completeness of SEER treatment data (sensitivity) and the accuracy of the SEER information (positive predictive value). RESULTS Based on 266 eligible patients, SEER's sensitivity in capturing initial treatment was 95.9% (118/123) for prostatectomy, 95.8% (69/72) for no treatment, 87.5% (21/24) for radiation therapy, 68.3% (28/41) for active surveillance or watchful waiting, and 50.0% (2/4) for cryosurgery. The SEER positive predictive value was 100% for radiation therapy and cryosurgery, 97.5% (118/121) for radical prostatectomy, 82.3% (28/34) for active surveillance or watchful waiting, and 78.4% (69/88) for no treatment. CONCLUSION The SEER data were highly sensitive and has a high positive predictive value for surgery and radiation therapy but underreported use of active surveillance. These results may assist researchers in understanding the strengths and weaknesses of using SEER prostate cancer treatment data.
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Affiliation(s)
- Ryan D Kraus
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, 1441 Eastlake Ave, Norris G350, Los Angeles, CA, 90033, USA
| | - Ann S Hamilton
- Department of Preventative Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Mari Carlos
- University of Southern California, Los Angeles, CA, USA
| | - Leslie K Ballas
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, 1441 Eastlake Ave, Norris G350, Los Angeles, CA, 90033, USA.
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Ram D, Rajappa SK, Rawal S, Singh A, Sharma KC, Dewan AK. Clinical Significance of Incidental Prostatic Carcinoma on Radical Cystectomy Histology Specimens: a Clinicopathological and Survival Analysis. Indian J Surg Oncol 2018; 9:192-198. [PMID: 29887700 DOI: 10.1007/s13193-018-0756-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 04/10/2018] [Indexed: 11/29/2022] Open
Abstract
Incidental prostatic carcinoma on radical cystectomy histology specimens is not an uncommon entity and managing such cases is still controversial. Classification into clinically significant and insignificant cancers by Epstein based on the assumption that one is more likely to affect the survival than the other is not universally accepted. We conducted this retrospective analysis with the aim to find out the role of dichotomization of incidental prostatic cancer into such classification. Patient's data were retrospectively reviewed from January 2013 to December 2014. A total of 175 patients underwent radical cystectomy during the study duration and amongst them, 38 specimens showed incidental prostatic cancer. Their data pertaining to demographic profile, clinicopathological details, treatment received, complications and follow-up data was recorded. On comparative analysis, the disease-free survival in csPCa (clinically significant prostatic cancer) group was 60.82% and cisPCa (clinically insignificant prostatic cancer) 62.68% at 2.3 years (p 0.566), while OS was 55.68% for csPCa and 87.5% for cisPCa respectively (p 0.814). The mean duration to recurrence was also comparable (19.4 months csPCa and 17 months cisPCa). None of the patients developed PSA elevation on follow-up and none of the recurrence or death were attributed to prostatic cancer. The stage of bladder cancer was the only factor, which had a significant impact on overall survival. The distinction between clinically significant and insignificant is not relevant according to our analysis.
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Affiliation(s)
- Dharma Ram
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Suhas K Rajappa
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Sudhir Rawal
- 2Department of Uro-Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Amitabh Singh
- 2Department of Uro-Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Kailash Chand Sharma
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Ajay Kumar Dewan
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
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Malte R, Kluth LA, Kaushik D, Boorjian SA, Abufaraj M, Foerster B, Rink M, Gust K, Roghmann F, Noldus J, Vordos D, Hagiwara M, Kikuchi E, Ikeda M, Matsumoto K, Karakiewicz PI, Rouprêt M, Briganti A, Scherr DS, Shariat SF, Seebacher V. Frequency and prognostic significance of incidental prostate cancer at radical cystectomy: Results from an international retrospective study. Eur J Surg Oncol 2017; 43:2193-2199. [DOI: 10.1016/j.ejso.2017.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/25/2017] [Accepted: 08/21/2017] [Indexed: 11/26/2022] Open
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Lopez-Beltran A, Cheng L, Montorsi F, Scarpelli M, Raspollini MR, Montironi R. Concomitant bladder cancer and prostate cancer: challenges and controversies. Nat Rev Urol 2017; 14:620-629. [DOI: 10.1038/nrurol.2017.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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